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General NPI Number Information
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NPI Number | 1962653063
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Entity Type | Organization
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Legal Business Name | MOUNTAIN HOME PSYCHIATRIC MEDICINE, PA
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 06/02/2023
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Provider Practice Location Address
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Address Line | 204 N COLLEGE ST
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City | MOUNTAIN HOME
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State | AR
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Zip | 72653-3654
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Country | US
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Telephone | 870-424-4804
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Fax | 870-424-8651
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Provider Business Mailing Address
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Address Line | PO BOX 387
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City | MOUNTAIN HOME
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State | AR
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Zip | 72654-0387
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Country | US
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Telephone | 870-424-4804
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Fax | 870-424-8651
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANNETTE S WALDEN
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Credential |
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Telephone | 870-424-4804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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